by Daniel Dorman; New York, Other Press, 2004, 280 pages, $25
Dr. Goldman is affiliated with the Center for Families and Children, Cleveland, Ohio, and with University Hospitals of Cleveland.
I must admit that when I read the premise of this book from the jacket, I was immediately skeptical. The author describes a patient's complete recovery from schizophrenia through psychotherapy alone, which refutes my five-year experience working in a community setting. However, because Dr. Dorman has had many more years of experience in psychiatry, I resolved to find out more about the treatment options available at the time of this patient's treatment and to keep an open mind. The following comments about this book are therefore a combination of my own thoughts—three years after completing a psychiatry residency that was strong in teaching both psychotherapy and psychopharmacology—and of discussions with colleagues about what psychiatric thought had been 34 years ago, when Dorman began a four-year treatment with the patient whose story he relates in this book.
We meet Catherine at age 17, and we follow her through a brief account of the two-year course of her illness until she is hospitalized. She begins treatment with Dorman at age 19 when she is hospitalized for the first time, and we then learn more details about her family life from Dorman's interviews with her mother, stepfather, and sister. We are told enough in these initial pages to know that Catherine's early years were very traumatic in a number of ways, including deaths, separations, and much emotional abuse. She became depressed and anorexic at about the same time and was treated only for the anorexia. Her depression worsened, and she began hearing voices five months later.
The bulk of the book details Catherine's lengthy hospitalizations and her psychotherapy treatments, which lasted about four years. It describes how Catherine became profoundly withdrawn, even catatonic at times, and extremely psychotic, with constant terrifying hallucinations degrading her and ordering her to kill herself and her mother. I had great difficulty with this part of the book, because I am not convinced that Catherine suffered from schizophrenia but perhaps from a severe depression with psychosis. I was left wondering why the antidepressants that might have curtailed her profound suffering were not tried at all, because there were some antidepressants available at that time that would not have produced intolerable side effects, unlike the thorazine that Catherine dreaded. This alternative diagnosis would also partly explain for me how Catherine could completely recover without medication and suffer no further relapse.
Perhaps the most interesting and useful part of this book is the thought-provoking last chapter. Here, Dorman discusses his personal views of the utility of medication versus psychotherapy in the context of questioning our definition of illness and the DSM model. Although I disagree with many points in this chapter, I applaud his method of thinking about pathology and therefore treatment in a psychodynamic context. His thoughts, although skewed mainly toward the psychoanalytic model, seem very timely in an era when we are beginning to question the current DSM structure and way of thinking. I think we have, at best, an uneasy alliance between prescribing medication and doing therapy, the polarity of which is reflected in our current DSM and in many psychiatry residency programs across the country. Perhaps our patients will be better served once we are able to take the best from both models and learn enough about the workings of the brain to persuade us that this is important enough to warrant doing battle with insurance companies and to help our patients in the best way we know how. Any psychiatrist who is willing to overlook this book's clear bias against medications will enjoy the psychodynamic discussions, and we all should be interested in the somewhat flawed but very stimulating last chapter in this era of politics and change.